Articles Posted in Health Law

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Plaintiffs, two individual psychiatrists and three professional associations of psychiatrists, filed suit against defendants, four health‐insurance companies, alleging that the health insurers’ reimbursement practices discriminate against patients with mental health and substance use disorders in violation of the Mental Health Parity and Addition Equity Act of 2008 (MHPAEA), 29 U.S.C. 1185(a), and the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001-1461. The court concluded that, because the psychiatrists are not among those expressly authorized to sue, they lack a cause of action under ERISA. The court also concluded that the association plaintiffs lack constitutional standing to pursue their respective ERISA and MHPAEA claims because their members lack standing. Accordingly, the court affirmed the judgment. View "Am. Psychiatric Ass’n v. Anthem Health Plans, Inc." on Justia Law

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Plaintiff filed a class action against the Commissioner, challenging New York’s coverage restrictions on certain medical services provided under its Medicaid plan. Plaintiffs argued that New York’s 2011 plan amendments, which restrict coverage of orthopedic footwear and compression stockings to patients with certain enumerated medical conditions, violate the Medicaid Act’s, 42 U.S.C. 1396 et seq., reasonable standards, home health services, due process, and comparability provisions, as well as the anti‐discrimination provision and integration mandate of Title II of the Americans with Disabilities Act (ADA), 42 U.S.C. 12131 et seq., and section 504 of the Rehabilitation Act, 29 U.S.C. 794. Because neither the Medicaid Act nor the Supremacy Clause confers a private cause of action to enforce the reasonable standards provision, the court vacated the district court’s grant of summary judgment to plaintiffs on that claim; the court declined to reach plaintiffs’ unequal treatment claim under the ADA and Rehabilitation Act as largely duplicative of their integration mandate claim; and the court affirmed the summary judgment rulings with respect to the remaining claims. Defendant is entitled to summary judgment on plaintiffs' home health services plan because orthopedic footwear and compression stockings constitute optional “prosthetics” rather than mandatory “home health services” under the Medicaid Act; defendant is entitled to summary judgment on the hearing element and plaintiffs are entitled to summary judgment on the notice element of plaintiffs’ due process claim, because the due process provision required New York to provide plaintiffs with written notice – though not evidentiary hearings – prior to terminating their benefits; plaintiffs are entitled to summary judgment on their comparability provision claim because New York’s coverage restrictions deny some categorically needy individuals access to the same scope of medically necessary services made available to others; and plaintiffs are entitled to summary judgment on their anti‐discrimination claims because New York’s restrictions violate the integration mandate of the ADA and Rehabilitation Act. Finally, the court vacated the injunction and remanded for further consideration on the appropriate relief because the injunction is broader than is warranted by the court's liability conclusions. View "Davis v. Shah" on Justia Law

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In 2000, the Secretary of Health and Human Services issued a regulation, known as the “reclassification rule,” 42 C.F.R. 412.230(a)(5)(iii), which provided that a hospital that has been reclassified from urban to rural under the Medicare Act, 42 U.S.C. 1395ww(d)(8)(E), may not thereafter receive an additional reclassification by the Medicare Geographic Classification Review Board (MGCRB) for reclassification as urban under subsection (d)(10). Lawrence filed suit seeking a preliminary injunction to enjoin defendants from applying the Secretary's reclassification rule to Lawrence's MGCRB application. The district court denied the motion. However, the court found the statutory language to be plain and unambiguous, and at odds with the Secretary’s reclassification rule, 42 C.F.R. 412.230(a)(5)(iii). Therefore, the court declared the regulation invalid and reversed the judgment of the district court, remanding for a determination of the appropriate remedy. View "Lawrence + Memorial Hosp. v. Burwell" on Justia Law

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Plaintiffs, a group of religious non-profit organizations affiliated with the Roman Catholic Archdiocese, filed suit challenging regulations promulgated under the Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111-148, 124 Stat. 119. The district court concluded that regulations promulgated under the Act that allow religious non-profit employers to opt out of providing contraceptive coverage themselves violate these religious employers’ rights under the Religious Freedom Restoration Act, 42 U.S.C. 2000bb et seq. The court concluded, however, that the challenged accommodation for religious objectors relieves, rather than imposes, any substantial burden on plaintiffs’ religious exercise, and thus does not violate the Religious Freedom Restoration Act. Accordingly, the court reversed the district court's judgment. View "Catholic Health Care Sys. v. Burwell" on Justia Law

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Plaintiffs, a group of religious non-profit organizations affiliated with the Roman Catholic Archdiocese, filed suit challenging regulations promulgated under the Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111-148, 124 Stat. 119. The district court concluded that regulations promulgated under the Act that allow religious non-profit employers to opt out of providing contraceptive coverage themselves violate these religious employers’ rights under the Religious Freedom Restoration Act, 42 U.S.C. 2000bb et seq. The court concluded, however, that the challenged accommodation for religious objectors relieves, rather than imposes, any substantial burden on plaintiffs’ religious exercise, and thus does not violate the Religious Freedom Restoration Act. Accordingly, the court reversed the district court's judgment. View "Catholic Health Care Sys. v. Burwell" on Justia Law

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Plaintiff filed suit, alleging that the DOH violated the Medicaid Act, 42 U.S.C. 1396 et seq., when it determined that guardianship fees approved by a state court could not be deducted from plaintiff’s Medicaid-required contributions to her nursing home costs. The district court dismissed the complaint based on lack of standing or, in the alternative, plaintiff failed to state a claim upon which relief could be granted. The court concluded that plaintiff did have standing where her injury was incurring debts beyond her means to the nursing facility or to her guardian. The court concluded, however, that plaintiff's claim failed on the merits because DOH was not under any unambiguous and binding obligation to allow deduction of the guardianship fees from plaintiff's net available monthly income. Accordingly, the court affirmed the judgment. View "Backer v. Shah" on Justia Law

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Home health care plaintiffs sought to prevent the Commissioner of the New York State Department of Health, from enforcing the Wage Parity Law, which sets the minimum amount of total compensation that employers must pay home care aides in order to receive Medicaid reimbursements for reimbursable care provided in New York City and Westchester, Suffolk, and Nassau Counties, N.Y. Pub. Health Law 3614‐c. Plaintiffs claim the Law was either preempted by the National Labor Relations 8 Act, 29 U.S.C. 151, or the Employee Retirement Income Security Act, 29 U.S.C. 1001, or was unconstitutional under the Due Process and Equal Protection Clauses. The Second Circuit affirmed the district court conclusion that the state law, except for one severable provision subdivision that singles out Taft‐Hartley plans for special treatment, is neither preempted nor unconstitutional. View "Concerned Home Care Providers, Inc. v. Cuomo" on Justia Law

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Plaintiffs filed a putative class action suit against the Secretary on behalf of Medicare beneficiaries who were placed into "observation status" by their hospitals rather than being admitted as "inpatients." Placement into "observation status" allegedly caused these beneficiaries to pay thousands of dollars more for their medical care. The district court granted the Secretary's motion to dismiss and plaintiffs appealed. The court affirmed the dismissal of plaintiffs' Medicare Act, 42 U.S.C. 1395, claims where plaintiffs lack standing to challenge the adequacy of the notices they received and nothing in the statute entitles plaintiffs to the process changes they seek. However, the court vacated the district court's dismissal of plaintiffs' Due Process claims where the district court erred in concluding that plaintiffs lacked a property interest in being treated as "inpatients," because the district court accepted as true the Secretary's assertion that a hospital's decision to formally admit a patient is "a complex medical judgment" left to the doctor's discretion. The district court's conclusion constituted impermissible factfinding, which in any event is inconsistent with the complaint's allegations that the decision to admit is guided by fixed and objective criteria. View "Barrows v. Burwell" on Justia Law

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Plaintiffs filed suit challenging the constitutionality of New York State's requirement that all children be vaccinated in order to attend public school. The statute provides two exemptions from the immunization mandate: a medical exemption and a religious exemption. Rejecting plaintiffs' substantive due process, free exercise of religion, equal protection, and Ninth Amendment challenges, the court concluded that the statute and regulation are a constitutionally permissible exercise of the State's police power and do not infringe on the free exercise of religion. The court further concluded that plaintiff's remaining arguments are either meritless or waived. Accordingly, the court affirmed the district court's grant of defendants' motion to dismiss. View "Phillips v. City of New York" on Justia Law

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Plaintiffs are health-service providers designated under federal law as Federally Qualified Health Centers (FQHC) and a trade association representing a number of FQHCs. Plaintiffs filed suit challenging New York's methods of reimbursing them for services they provide under Medicaid, seeking injunctive relief under 42 U.S.C. 1983. The district court upheld for the most part the Commissioner's methods for reimbursing FQHCs but granted prospective relief to plaintiffs for reimbursement for certain services they provide to patients enrolled with Medicaid Managed Care Organizations (MCOs). The court concluded that, as to the questions presented on appeal - with only one exception - there are no disputed issues of material fact, and that summary judgment was appropriate; the court agreed with the district court's approach to, and analysis of, the majority of the issues before the court; the court affirmed the grant of summary judgment to the Commissioner on most issues involving his methodologies for reimbursing FQHCs, and affirmed the grant of summary judgment to the FQHCs on issues involving their reimbursement for services provided to MCO enrollees; the court found that the district court erred in concluding that there were no disputed issues of material fact with respect to the Commissioner's methodology for calculating its prospective obligation to make a wraparound payment to FQHCs that provide services under a contract with an MCO; and the court vacated in limited part the district court's grant of summary judgment to the Commissioner and remanded for further proceedings. View "Community Health Care Assoc. of N.Y. v. Shah" on Justia Law

Posted in: Health Law